Big risk - Two-thirds of J'cans are without health insurance; say they can't afford it or it's not necessary

Less than a third (32 per cent) of adult Jamaicans say they have health insurance, but more than half of these (53 per cent) have coverage only because they are part of workplace schemes. Forty-five per cent of the people with insurance are in individual plans.

However, an overwhelming majority (89 per cent) would like the Government to implement a national health insurance arrangement similar to what exists in countries like Britain or Canada but without any clear idea of how it is to be funded - a job the Andrew Holness administration recently assigned to a group headed by businessman and chairman of the National Health Fund (NHF) Chris Zacca.

The findings are contained in a survey conducted in September by Bill Johnson's polling organisation for The Gleaner, in collaboration with the NHF, and appear to broadly confirm insurance industry data on the number of Jamaicans under their health plans.

According to the Insurance Association of Jamaica (IAJ), up to last December, 368,181 Jamaicans, or approximately 14 per cent of the overall population, were part of employer-funded health arrangements as opposed to those who had individual plans. However, people in these employer plans represented less than 30 per cent of the employed labour force of around 1.3 million people. Forty-three per cent of those on the insurance rolls were dependents of insured workers. Or looked at another way, there are only a third more primary insured people in workplace-related schemes than there are dependents.

Based on these numbers and an extrapolation of others with individual and other plans, it would appear that between half a million and 600,000 Jamaicans have access to some kind of insurance. But whatever the precise total, Eric Hosin, the president of the IAJ and CEO of the Guardian Insurance Group, believes the number to be "very low" for the size of Jamaica's population and workforce.

INSURANCE PAYOUT

Last year, insurance companies paid out $15.2 billion in health-related claims, and officials say the industry operates on tight margins. "There is a need to get more persons to purchase health insurance, especially group health insurance, which allows for better spreading of risks. It is cheaper," Hosin told The Gleaner. "Also, in many instances, the company will assist to pay the premiums. In addition, as a rider to the policy, persons can get health insurance for spouses and children."

Of the approximately two-thirds of Jamaicans without health insurance, not able to afford it (44 per cent) was the main reason they gave for the situation, followed by 10 per cent who deemed such policies to be unnecessary, while 10 per cent indicated that they planned to sign up. When people were asked specifically if they believed health insurance was affordable in Jamaica, 55 per cent said no, against a quarter who believed it was, and a fifth who had no position.

The majority sentiment is one with which 29-year-old Tashena Howell has sympathy, although she maintains policies for herself and her mother. Howell, who owns a shop, says meeting the $10,000 premium is tough. She bought her first policy five years ago. "If it is something that you really want, you have to sacrifice," she said. "In the end, it will pay off. It's a risky thing not having insurance. Having insurance is a backup plan."

But with most Jamaicans insisting that they simply cannot afford health insurance, trade unionist Danny Roberts, who runs the Hugh Lawson Shearer Trade Union Education Institute, argues that the Government has to lead the way in meeting the demand. He insisted that while it would help provide a cushion for the society's most vulnerable, such an action shouldn't be seen as narrow welfarism. "That has to be connected to employers in Jamaica fulfilling the demands of the labour relations code and a drive for greater production and efficiency," Roberts said.

SEPTEMBER SURVEY

In fact, in the September survey, 85 per cent of Jamaicans with health-care insurance said they would get it if it was available, which, on the face of it, is another approach to the affordability question. That number was just four points behind the 89 per cent who like the idea of a government plan.

Significantly, there was hardly any difference between men and women on this issue as well as among people of working age. The age groups in which there was the least hankering for health insurance if it was available were those in the 55-64 (74 per cent) and over 65 brackets (77 per cent).

In the 1990s, during the P.J. Patterson administration, Peter Phillips, then the health minister, with support from international agencies, did preliminary work on a national health-insurance scheme but couldn't, at the time, figure out a sustainable financing arrangement. The idea was eventually shelved.

Chris Zacca, whose agency finances medicines and supports health programmes from sin taxes, has been given the job - by the Jamaica Labour Party government which, eight years ago, removed hospital user-fees at public hospitals, with, many experts agree, deleterious effects - to revive the effort.

Horace Dalley, Phillips' People's National Party colleague, who served briefly as health minister in 2015 and now shadows the portfolio, supports the principle of a national health insurance but wants a robust debate, including in Parliament, on what the Government has in mind

"What it means, as is being proposed, is that those who are working will have to pay for those who are not working," Dalley said. "I want to see a scheme, and I'm waiting for the debate to start where every single Jamaican will pay something towards insurance. You can't force people to pay. I don't know how it's going to be done."

jovan.johnson@gleanerjm.com